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What are the tree components that should be present so that a patient can be diagnosed w/ DKA?
- Presence of ketones (in serum or urine)
- Presence of acidoisis (serum bicarbonate<18 mEq/L and or arterial pH <7.3)
What do we look at to classify the severity of DKA?
- Serum Bicarbonate (meq/L)
- Arterial pH
- Anion gap
- Mental Status
Criteria to diagnose mild DKA
- Serum Bicarbonate (meq/L):15-18
- Arterial pH: 7.25-7.30
- Anion gap: >10
- Mental Status: Alert
Criteria to diagnose moderate DKA
- Serum Bicarbonate (meq/L):10-15
- Arterial pH:7.0-7.24
- Anion gap:>12
- Mental Status:Alert/drowsy
Criteria to diagnose severe DKA
- Serum Bicarbonate (meq/L):<10
- Arterial pH: <7.0
- Anion gap:>12
- Mental Status: Stupor/coma
What are the three elements of DKA?
- Marked hyperglycemia
What process will increase in the absent or insufficient insulin?
Clinical Presentation of DKA
- Physical signs: dehydration, dry mucus membranes, decreased skin turgor, tachycardia, Kussmaul respirations (rapid adn deep breathing) with acetone smell, hypotension, alteration in mental status, shock, and coma.
- The history generally: polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain, weakness, and drowsiness.
Anion gap is calculated as
Sodium - (Chloride + Bicarbonate)
The initial management of DKA
- 1. Fluid and electrolyte therapy
- 2. Insulin therapy
- 3. Treatment of precipitating causes
- 4. Monitoring of therapy and complications
Precipitating factors of DKA
- New onset type 1 diabetes
- Inadequate insulin
- Poor compliance
- Myocardial infarction
- Cerabral vascular accident
- Acute pancreatitis
Signs and symptoms of DKA
- Signs of poorly controlled diabetes
- Symptoms of the precipitating factor
- Kussmaul respirations
- Acetone smell on breath
- Abdominal pain
Total body water deficit formulation
0.6 x kg x [1- (140/Na)]
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